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European Heart Journal Advance Access originally published online on September 4, 2006
European Heart Journal 2006 27(19):2353-2361; doi:10.1093/eurheartj/ehl233
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

The diagnostic utility of N-terminal pro-B-type natriuretic peptide for the detection of major structural heart disease in patients with atrial fibrillation

Rhidian J. Shelton*, Andrew L. Clark, Kevin Goode, Alan S. Rigby and John G.F. Cleland

Department of Cardiology, Castle Hill Hospital, Cottingham, Kingston-upon-Hull HU16 5JQ, UK

Received 7 February 2006; revised 11 July 2006; accepted 17 August 2006; online publish-ahead-of-print 4 September 2006.

* Corresponding author. Tel: +44 1482 624073; fax: +44 7902 840055. E-mail address: rhidianshelton{at}btopenworld.com

Aims To assess the role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the diagnosis of major structural heart disease (MSHD) in patients with atrial fibrillation (AF) compared with those with sinus rhythm (SR) using receiver operator characteristic (ROC) analysis. NT-proBNP is elevated in MSHD and heart failure (HF). AF, a common finding in HF and MSHD, is also associated with raised plasma NT-proBNP. As a result, the utility of NT-proBNP for predicting MSHD may be reduced.

Methods and results One thousand four hundred and seventy-six patients underwent assessment at a single centre, performed without the knowledge of NT-proBNP levels. MSHD included left ventricular (LV) systolic and diastolic dysfunctions, left-sided valvular disease, right heart disease (including pulmonary hypertension) and severe LV hypertrophy. One hundred and fifty-five patients were excluded due to renal impairment, atrial flutter, or a pacemaker. Seven hundred and ninety-three patients were diagnosed with MSHD. Median NT-proBNP concentrations for patients with MSHD were 960 (IQR 359–2625) pg/mL and 2491 (1443–4368) pg/mL for SR (n=591) and AF (n=202), respectively (P<0.001). Patients without MSHD had NT-proBNP levels of 179 (90–401) pg/mL and 1000 (659–1760) pg/mL for SR (n=454) and AF (n=74), respectively (P<0.001). The area under the ROC curve for NT-proBNP to detect MSHD was 0.79 for SR (95% CI 0.77–0.82) and 0.78 for AF (95% CI 0.72–0.84). NT-proBNP cut-off levels necessary to achieve a 1 in 100 false negative rate were 27.5 (7.5–30.5) pg/ml and 524 (253–662) pg/ml for SR and AF, respectively.

Conclusion NT-proBNP performs as well in patients with SR as in those with AF. However, significantly higher cut-off levels are required for patients with AF to achieve similar levels of diagnostic specificity.

Key Words: Atrial fibrillation • Heart failure • Natriuretic peptides


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